CSP Flashcards
1
Q
CSP - ROM
A
- Flexion - 60
- Extension - 60
- Lateral flexion - 45
- Rotation - 80
- TMJ - 35 - 50 mm opening
2
Q
CSP - MYOTOMES
A
- Cervical flexion - C1, C2
- Cervical extension - C2, C3, XI
- Cervical lateral flexion - C3
- Shoulder elevation - C4, XI
- Deltoid - C5, C6 - axillary
- Brachioradialis - C5, C6 - radial
- Biceps - C5, C6 - musculocutaneous
- Triceps - C6, C7, C8, T1 - radial
- Wrist extensors - C6, C7, C8 - radial
- Wrist flexors - C6, C7 - median/ulnar
- Finger flexors - C7, C8, T1 - ulnar/median
- Interossei - C7, C8, T1 - ulnar
3
Q
CSP - ORTHO TESTS - VBI
A
VBI - Vertebral basilar artery function test
4
Q
CSP - ORTHO TESTS - INSTABILITY
A
- INSTABILITY - Lateral shear test
5
Q
CSP - ORTHO TESTS - RADICULOPATHY
A
- RADICULOPATHY/NERVE TENSION - Cervical compression/distraction, Brachial plexus compression test
6
Q
CSP - ORTHO TESTS - SPRAIN/STRAIN
A
- SPRAIN/STRAIN - Cervical distraction
7
Q
CSP - JOINT TYPE
A
- Gliding - zygapophyseal joints
- Pivot - atlantoaxial joint
- Fibrocartilaginous - intervertebral joints
- Hinge and gliding - TMJ
8
Q
CSP - ARTICULAR SURFACES
A
- Atlanto-occipital joint - convex (occipital condyles of occiput) on concave (superior articular facets of atlas)
- Atlantoaxial - concave (articular facet of dens on atlas) on convex (anterior facet of dens on axis)
- Zygapophyseal - facets are orientated at 45
- Intervertebral discs - horizontal plane
- TMJ - convex (mandibular condyle on disc) on concave (mandibular fossa of temporal bone)
9
Q
CSP - MAIN MUSCLE ACTIONS - FLEXION
A
- FLEXION - sternocleidomastoid, longus cervicis, longus capitis, rectus capitis anterior
10
Q
CSP - MAIN MUSCLE ACTIONS - EXTENSION
A
- EXTENSION - trapezius, splenius cervicis & capitis, longis capitis, levator scapulae, suboccipitals
11
Q
CSP - MAIN MUSCLE ACTIONS - LATERAL FLEXION
A
- LATERAL FLEXION - scalenes, levator scapula, longissimus capitis, splenius capitis & cervicis, rectus capitis lateralis
12
Q
CSP - MAIN MUSCLE ACTIONS - ROTATION
A
- ROTATION - SCM, longus capitis & coli, rotatores, splenius, suboccipitals
13
Q
CSP - RESTING POSITION
A
Csp: slight extension
TMJ: mouth closed with teeth not in contact
14
Q
CSP - CLOSED PACKED POSITION
A
Csp: full extension
TMJ: teeth clenched
15
Q
CSP - NORMAL END FEEL
A
Tissue stretch (for all actions)
16
Q
CSP - ABNORMAL END FEEL
A
Early myospasm - muscle/ligament tear
Late myospasm - instability
Empty - ligament rupture
Hard - bone approximation (osteophyte)
17
Q
CSP - COUPLED MOTIONS
A
C2-C7 vertebra
- Left lateral flexion coupled with left rotation
- Right lateral flexion coupled with right rotation
18
Q
CSP - CONDITIONS - RADICULOPATHY
A
Hx - numbness, tingling, weakness or shooting electrical pain down the arm
S&S - decreased pain when supine; +ve neruological signs (decreased DTR, muscle weakness, decreased sensation) ; +ve cervical compression for arm pain
DDx - disc herniation, IVF encroachment, space occupying lesion, TOS
19
Q
CSP - CONDITIONS - OSTEOARTHRITIS
A
Hx - patient > 50; gradual onset; crepitus; morning stiffness; dull, achy pain
S&S - decreased pain with movement, worse at rest; limited AROM; confirm on x-ray (decreased joint space, osteophyte formation)
DDx - rheumatoid, IVF encroachment, ankylosing spindylitis
20
Q
CSP - CONDITIONS - CERVICAL STRAIN
A
Hx - trauma or overuse; muscle pain/soreness
S&S - tender to palpation; AROM limited by pain; pain with muscle testing
DDx - cervical sprain, facet syndrome, meniscoid entrapment
21
Q
CSP - CONDITIONS - CERVICAL JOINT DYSFUNCTION
A
Hx - insidious onset of local pain or discomfort
S&S - tender to palpation; limited joint play; local my-spasm; bone out of place
DDx - cervical sprain, facet syndrome, meniscoid entrapment
22
Q
CSP - CONDITIONS - FACET SYNDROME
A
Hx - well localised unilateral pain that may radiate to shoulder, antalgic posture
S&S - increased pain with extension (loading facets); +ve cervical compression (local pain)
DDx - cervical sprain, menisci entrapment, torticollis
23
Q
CSP - CONDITIONS - INSTABILITY
A
Hx - recurrent neck pain or clicking or clunking sensation
S&S - increased PROM with over pressure; x-ray flexion/extension views will show increased ROM
DDx - cervical sprain, OA
24
Q
CSP - CONDITIONS - TMJ SYNDROME
A
Hx - jaw/facial pain worse with eating; locking or catching of the jaw; chronic headaches
S&S - decreased ROM due to pain, crepitus, tenderness to palpation
DDx - Bell’s palsy, trigeminal neuralgia, dental infection
25
CSP - CONDITIONS - VBI
Hx - atherosclerosis, hypertension, diabetes, smoking, ligamentous hypermobility
S&S - vertigo, dizziness, unsteadiness, visual changes, nystagmus; +ve VBI tests
DDx - stroke, TIA, positional vertigo
26
CSP - ORTHO TESTS - BIKELE'S SIGN
- Pt seated
- Shoulder abducted 90, elbow fully flexed
- Examiner instructs pt to extend elbow
27
CSP - ORTHO TESTS - BIKELE'S SIGN - POSITIVE TEST
**Nerve root tension, brachial plexus neuritis, possibly meningitis**
- Reproduction of radicular symptoms
28
CSP - ORTHO TESTS - BRACHIAL PLEXUS STRETCH TEST
- Pt seated or supine
- Examiner passively abducts straight arm and observes for signs of discomfort
- Then extends patients wrist
- Then laterally flexes head and extends wrist
29
CSP - ORTHO TESTS - BRACHIAL PLEXUS STRETCH TEST - POSITIVE TEST
**Cervical radiculopathy (commonly C5)**
- Reproduction of radicular symptoms with wrist extension
**Myofascial contracture**
- Local ‘stretch’ in arm or forearm
30
CSP - ORTHO TESTS - BRUDZINSKI’S SIGN
- Pt supine with legs straight
- Examiner flexes pt head and neck
31
CSP - ORTHO TESTS - BRUDZINSKI’S SIGN - POSITIVE TEST
**Meningeal irritation/inflammation (meningitis)**
- Involuntary hip and knee flexion
32
CSP - ORTHO TEST - SPURLING'S TEST
- Pt seated
- Examiner gently applies axial downward pressure on pt head in neutral position
- Examiner gently applies downward pressure with neck in extension
- Examiner gently applies downward pressure with head in extension and mild rotation to the affected side
- Examiner gently applies downward pressure with head in extension and mild rotation and side bent to the affected side
33
CSP - ORTHO TEST - SPURLING'S TEST - POSITIVE TEST
**Increased pressure on nerve roots, IVF encroachment, DJD osteophyte, radiculopathy**
- Increased peripheral pain
- Numbness
**Local sprain/strain, joint damage, facet lock, menisci entrapment, cervical subluxation**
- Local neck pain
34
CSP - ORTHO TEST - SPURLING'S TEST - SN & SP
**SN:** 11-100
**SP:** 74-100
35
CSP - ORTHO TEST - JACKSON'S COMPRESSION
- Pt seated
- Examiner gently applies axial downward pressure on pt head in neutral position
- Examiner gently applies downward pressure with neck in extension
- Examiner gently applies downward pressure with head in extension and mild rotation to the affected side
36
CSP - ORTHO TEST - JACKSON'S COMPRESSION - POSITIVE TEST
**Increased pressure on nerve roots, IVF encroachment, DJD osteophyte, radiculopathy**
- Increased peripheral pain
- Numbness
**Local sprain/strain, joint damage, facet lock, menisci entrapment, cervical subluxation**
- Local neck pain
37
CSP - ORTHO TEST - CERVICAL DISTRACTION
- Pt seated or supine
- Examiner stabilises under occiput and mandible
- Pt takes a deep breath in
- Examiner distracts pt head on exhalation
38
CSP - ORTHO TEST - CERVICAL DISTRACTION - POSITIVE TEST
**Muscle, ligament or joint capsule damage**
- Increased local pain
**Decreased pressure on nerve roots, IVF encroachment, cervical radiculopathy**
- Decreased peripheral pain/numbness
**SN**: 40-50
**SP**: 80-100
**Facet impingement, DJD**
- Decreased local pain
39
CSP - ORTHO TEST - L’HERMITTE’S SIGN
- Pt seated or supine
- Pt head is passively flexed forward
- Examiner pay apply gently over pressure
40
CSP - ORTHO TEST - L’HERMITTE’S SIGN - POSITIVE TEST
**Cervical radiculopathy**
- Reproduction of radicular symptoms (sharp, shooting pain down spine or extremities)
41
CSP - ORTHO TEST - L’HERMITTE’S SIGN - SN & SP
**SN**: 3-89
**SP**: 41-97
42
CSP - ORTHO TEST - UPPER LIMB TENSION TEST
- Pt supine with shoulder in a depressed position (the depressed shoulder must remain for the entire test) and head laterally flexed away from the side being examined
- Examiner slowly moves the arm towards the end range
- **MEDIAN NERVE**: shoulder depressed and abducted 110, elbow, wrist and fingers extended, forearm supinated
- **MEDIAN, MUSCULOCUTANEOUS, AXILLARY NERVE**: shoulder depressed, externally rotated and abducted 10, elbow, wrist and fingers extended, forearm supinated
- **RADIAL NERVE**: shoulder depressed, externally rotated and abducted 10, elbow extended, forearm pronated, wrist flexed and deviated towards ulna, fingers flexed
- **ULNAR NERVE**: shoulder depressed, externally rotated and abducted 90 (pt hand should approximate ipsilateral ear), elbow flexed, forearm supinated, wrist extended and deviated towards the radius, fungers extended
43
CSP - ORTHO TEST - UPPER LIMB TRACTION TEST - POSITIVE TEST
**Radiculopathy, peripheral nerve or fascial adhesions**
- Arm pain
- Reproduction of neurologic symptoms
44
CSP - ORTHO TEST - UPPER LIMB TRACTION TEST - SN & SP
**MEDIAN NERVE** - **SN**: 97 **SP**: 22
**RADIAL NERVE** - **SN**: 72 **SP**: 33
45
CSP - CERVICAL STRAIN - DEFINITION
- Whiplash
- Causes Muscular + ligamentous structures of the cervical spine to be stretched beyond physiologic capacity
46
CSP - CERVICAL STRAIN - CAUSES
- Sudden hyperextension followed by hyper-flexion of the neck.
- Commonly from Rear end automobile collisions or Sports trauma
47
CSP - CERVICAL STRAIN - CLINICAL PRESENTATION
- Neck pain
- Persistent stiffness
- Trapezial/upper back pain
- Muscle spasm
- Headaches
- Limited ROM
- Must be aware to the discomfort it causes patients, however it usually has a benign course + minimal long term sequelae (an aftereffect of an injury)
- Our job to rule out morbid conditions, e.g. bony fracture from the large majority of cervical strains. Must be able to identify Ps with bone and neurologic pathology such as fractures, dislocations and spinal cord injuries that mimic the condition of a cervical strain
48
CSP - CERVICAL STRAIN - PROGNOSIS
- In at least 40% of people, there should be some resolution of symptoms by 6 weeks, and by 12 weeks, there should be complete resolution in at least 40% of people.
- Approximately 50% of people fully recover within 1 year of WAD.
49
CSP - CERVICAL DEGENERATION - DEFINITION
- Spontaneous degeneration of either disc or facet joints
50
CSP - CERVICAL DEGENERATION - CAUSES
- Accumulated wear and tear that occurs over a long period of time
51
CSP - CERVICAL DEGENERATION - AGE GROUPS AFFECTED
- Elderly
- By the age of 35, approximately 30% of people will show evidence of disc degeneration at one or more levels.
- By the age of 60, more than 90% of people will show evidence of some disc degeneration
52
CSP - CERVICAL DEGENERATION - RISK FACTORS
- Ageing
- Tough manual labour jobs
- Vigorous sports e.g. rugby
53
CSP - CERVICAL DEGENERATION - CLINICAL PRESENTATION
- Neck pain
- Stiffness
- Decreased ROM
- Numbness, tingling, or even weakness in the neck, arms and shoulders are additional symptoms due to nerves in the cervical area becoming irritated or pinched
- Pts should be asked to perform flexion, extension and rotational movements and report whether neck pain increases or decreases.
54
CSP - CERVICAL DEGENERATION - PROGNOSIS
- Symptoms worsen if left untreated
- Treatment centred around reliving pain, wont fully treat/relive symptoms
55
CSP - CERVICAL HERNIATION - DEFINITION
- When the outer part (annulus fibrosus) gets tears or splits, the gel (nucleus pulposus) can poke out. This is what it means for a disk to become herniated. (think jam donut)
56
CSP - CERVICAL HERNIATION - CAUSES
- Traumatic events, some spontaneous cases
- Most occur between C5 and T1
57
CSP - CERVICAL HERNIATION - AGE GROUPS AFFECTED
- More common in elderly due to wear and tear & less water in discs
58
CSP - CERVICAL HERNIATION - RISK FACTORS
- Age
- Lack of regular exercise
- Tobacco use
- Poor posture (i.e., incorrect lifting or twisting causing additional stress on the cervical spine)
- Injury
59
CSP - CERVICAL HERNIATION - CLINICAL PRESENTATION
- Frequent headaches
- Limited ROM
- Pain that originates around the paraspinal muscles radiates down one of the upper extremities
- Paraspinal muscles may go into spasm, causing discomfort on palpation
- Finger numbness and tingling
- Can cause spinal cord compression, where disc material pushes directly on spinal cord
60
CSP - CERVICAL HERNIATION - PROGNOSIS
- Over 95% of people with arm pain due to a herniated disc improve in about six weeks and return to normal activity. If you don’t respond to conservative treatment or your symptoms get worse, surgery may be recommended.
61
CSP - CERVICAL STENOSIS - DEFINITION
- A condition in which the spinal canal is too small for the spinal cord and nerve roots. This can cause damage to the spinal cord.
62
CSP - CERVICAL STENOSIS - CAUSES
- Bone spurs.
- Herniated discs.
- Thick ligaments - can become stiff and thick over time. Thick ligaments can push into the spinal canal.
- Tumors - Rarely, tumors can form inside the spinal canal.
- Spinal injuries
63
CSP - CERVICAL STENOSIS - AGE GROUPS AFFECTED
- Most people with spinal stenosis are over age 50
64
CSP - CERVICAL STENOSIS - RISK FACTORS
- Scoliosis or other spinal problems.
65
CSP - CERVICAL STENOSIS - CLINICAL PRESENTATION
- Numbness
- Tingling or weakness in a hand, leg, foot or arm
- Neck pain
- Common to present vague neurological symptoms -
- Problems with walking and balance
- Bowel and bladder inconsistence
- Pts expected to have hyperreflexia in the in their upper and lower extremities
66
CSP - CERVICAL STENOSIS - PROGNOSIS
- Spinal stenosis symptoms often become worse over time, but this may happen slowly. If the pain does not respond to these treatments, or you lose movement or feeling, you may need surgery.
67
CSP - CERVICAL FACET SYNDROME - DEFINITION
- A type of osteoarthritis that occurs when the structure of one or more of the vertebral facet joints begins to deteriorate
68
CSP - CERVICAL FACET SYNDROME - CAUSES
- Disk degeneration and disk narrowing increase facet joint loading and consequently facet osteoarthritis
69
CSP - CERVICAL FACET SYNDROME - AGE GROUPS AFFECTED
- 50 and above
70
CSP - CERVICAL FACET SYNDROME - RISK FACTORS
- Genetic disposition
- Smoking
- Either sedentary jobs at a computer or high levels of repeated muscle tension
71
CSP - CERVICAL FACET SYNDROME - CLINICAL PRESENTATION
- Unilateral pain without radiation to the arm
- Rotation and retroflexion are frequently painful or limited
- Pain with pressure on the dorsal side of the spinal column at the level of the facet joints
- Pain and limitation of extension
- Absence of neurological symptoms
72
CSP - CERVICAL FACET SYNDROME - PROGNOSIS
- Can get better through manipulation and mobilisation
73
CSP - CERVICAL ARTERY DYSFUNCTION - DEFINITION
- Umbrella term for rare vascular problems of the neck, can involve the internal carotid and/or vertebral arteries.
74
CSP - CERVICAL ARTERY DYSFUNCTION - CAUSES
- Acute injury or linked to other conditions.
- Hyoid bone has also been described as a potential mechanical compressor of the internal carotid artery
75
CSP - CERVICAL ARTERY DYSFUNCTION - AGE GROUPS AFFECTED
- Internal most common 35-55
- External 55 and above
76
CSP - CERVICAL ARTERY DYSFUNCTION - RISK FACTORS
- Whiplash in case history
- Smoking habits, poor lifestyle such as diet/nutrition, overweight,
- Previous stroke and vascular presentations like hypertension
77
CSP - CERVICAL ARTERY DYSFUNCTION - CLINICAL PRESENTATION
- Neck and head pain.
- Headaches.
- Dizziness.
- Blurred vision.
- Balance disturbance.
- Speech or swallowing issues.
- Increase in blood pressure.
- Facial numbness.
- Nystagmus (involuntary eye movements).
- Feeling sick or faint.
- Loss of taste.
78
CSP - CERVICAL ARTERY DYSFUNCTION - PROGNOSIS
- Not fully curable but symptoms can be minimised
79
CSP - TRIGGER POINTS - DEFINITION
- Hyperrritable spot, a palpable nodule in the taut bands of the skeletal muscles’ fascia.
- Direct compression or muscle contraction can elicit jump sign, local tenderness, local twitch response and referred pain which usually responds with a pain pattern distant from the spot
80
CSP - TRIGGER POINTS - CAUSES
- Acute trauma or repetitive micro trauma, leading to developmental stress on muscle fibres
- Lack of exercise
- Acute sports injuries
81
CSP - TRIGGER POINTS - AGE GROUPS AFFECTED
- Common in men between 30 and 55 with lack of exercise
82
CSP - TRIGGER POINTS - RISK FACTORS
- Occupational or recreational activities that produce repetitive stress on a specific muscle/group commonly cause chronic pain leading to trigger points
- Prolonged poor posture
- Joint problems
83
CSP - TRIGGER POINTS - CLINICAL PRESENTATION
- Regional persistent pain, decreased ROM
- Muscles used to maintain body posture, neck, shoulders and pelvic floor muscles
- Tension headaches, tinnitus
- Muscle weakness or imbalance
- Painful movement and/or movement that sometimes can exacerbate symptoms.
- Postural abnormalities and compensations.
84
CSP - TRIGGER POINTS - PROGNOSIS
- Can loosen through treatment
85
CSP - ACUTE DISC PROLAPSE - DEFINITION
- Slipped disc pressing on a nerve root
86
CSP - ACUTE DISC PROLAPSE - CAUSES
- Sudden unguarded flexion and rotation
- Predisposed abnormality of disc with increased nuclear tension
87
CSP - ACUTE DISC PROLAPSE - AGE GROUPS AFFECTED
- 30-50
88
CSP - ACUTE DISC PROLAPSE - RISK FACTORS
- Genetics, smoking, ageing, improper lifting
89
CSP - ACUTE DISC PROLAPSE - CLINICAL PRESENTATION
- Pain and stiffness in the neck
- Pain radiating to scapular region and occiput
- Pain and paraesthesia in one lower limb, radiating to the outer elbow, back of wrist, index and middle fingers
- Neck may be tilted forwards and sideways
- Muscles tender and movements restricted
- Arm can be examined for signs of nerve root irritation or compression
90
CSP - ACUTE DISC PROLAPSE - PROGNOSIS
- Can improve with treatment
91
CSP - PYOGENIC INFECTION - DEFINITION
- Local inflammation of skin, soft tissue and bodily parts which are mainly caused by invasion and multiplication of pathogenic microorganism
92
CSP - PYOGENIC INFECTION - CAUSES
- Pathogen, usually staphylococcus, reaches the spine via the blood stream.
- Initially destructive changes are limited to the intervertebral disc space and the adjacent parts of vertebral bodies
- Later, abscess formation occurs and pus may extend into spinal canal or soft tissue planes of the neck
93
CSP - PYOGENIC INFECTION - AGE GROUPS AFFECTED
- Can affect any age
94
CSP - PYOGENIC INFECTION - CLINICAL PRESENTATION
- Pain in the neck, often associated with muscles spasm and stiffness
- Severely limited neck ROM
- Blood tests may show a leucocytosis and an elevated erythrocyte sedimentation rate
95
CSP - PYOGENIC INFECTION - PROGNOSIS
- Antibiotic treatment works best in the early stage
- Rest
96
CSP - TUBERCULOSIS - DEFINITION
- Spinal infection caused by tuberculosis
97
CSP - TUBERCULOSIS - CAUSES
- Blood borne infection that localises in the intervertebral disc and the anterior parts of the adjacent vertebral bodies
- As bone crumbles the Cspine collapses into kyphosis
- Retropharyngeal abscess forms and points behind sternomastoid muscle at the side of the neck
98
CSP - TUBERCULOSIS - AGE GROUPS AFFECTED
- Usually children
99
CSP - TUBERCULOSIS - CLINICAL PRESENTATION
- Neck pain and stiffness
- Retropharyngeal abscess (in neglected cases) causes difficulty swallowing. Shows as swelling in posterior triangle of neck
- Neck extremely tender, all movements limited
- In late cases there may be obvious kyphosis
- X-rays show narrowing of disc space and erosion of adjacent vertebral bodies
100
CSP - TUBERCULOSIS - PROGNOSIS
- Immobilisation of the neck in a brace for 6-18 months and antituberculosis drugs
101
CSP - RHEUMATOID ARTHRITIS - DEFINITION
- Long-term condition that causes pain, swelling and stiffness in the joints.
- The condition usually affects the hands, feet and wrists.
102
CSP - RHEUMATOID ARTHRITIS - AGE GROUPS AFFECTED
- Mainly women, elderly
103
CSP - RHEUMATOID ARTHRITIS - RISK FACTORS
- Family history.
- Smoking.
- Excess weight.
104
CSP - RHEUMATOID ARTHRITIS - CLINICAL PRESENTATION
- Neck pain and noticeable restriction
- Tender, warm, swollen joints
- Joint stiffness that is usually worse in the mornings and after inactivity
- Fatigue, fever and loss of appetite
- Lower limb weakness due to cord compression in extreme cases
105
CSP - RHEUMATOID ARTHRITIS - PROGNOSIS
- No cure for rheumatoid arthritis, early treatment and support (including medicine, lifestyle changes, supportive treatments and surgery) can reduce the risk of joint damage and limit the impact of the condition.
106
CSP - AROM - FLEXION - MUSCLES ACTIVATED
Sternocleidomastoid
Longus cervicis
Longus captius
Rectus capitus anterior
**Eccentric** contraction of: Upper trapezius, splenius, semispinalis, longissimus capitis
107
CSP - AROM - FLEXION - TISSUES STRETCHED
Trapezius
Splenius cervicis & capitis
Longissimus capitis
Suboccipitals
Nuchal ligament
Interspinous ligament
Posterior IVD
Posterior facet joint capsule
108
CSP - AROM - FLEXION - TISSUES COMPRESSED
Anterior neck muscles
Trachea
Oesophagus
Carotid arteries
109
CSP - AROM - EXTENSION - MUSCLES ACTIVATED
Upper trapezius
Splenius cervicis & capitis
Longissimus capitis
Suboccipitals
110
CSP - AROM - EXTENSION - TISSUES STRETCHED
Anterior neck muscles
Anterior longitudinal ligament
Anterior IVD
Trachea
Oesophagus
Carotid arteries
111
CSP - AROM - EXTENSION - TISSUES COMPRESSED
Posterior neck muscles
Posterior IVD
Facet joints
Vertebral arteries
112
CSP - AROM - SIDE BENDING - MUSCLES ACTIVATED
**Ipsilateral**
Upper trapezius
Splenius cervicis & capitis
Longissimus capitis
Levator scapulae
Suboccipitals
113
CSP - AROM - SIDE BENDING - TISSUES STRETCHED
**Contralateral**
Upper trapezius
Longissimus capitis
SCM
Lateral IVD
Carotid artery
Z-joints
114
CSP - AROM - SIDE BENDING - TISSUES COMPRESSED
**Ipsilateral**
Upper trapezius
Longissimus capitis
SCM
Lateral IVD
Carotid artery
Z-joints
115
CSP - AROM - ROTATION - MUSCLES ACTIVATED
**Ipsilateral**
- Splenius cervicis & capitis
- Suboccipitals
**Contralateral**
- SCM
116
CSP - AROM - ROTATION - TISSUES STRETCHED
**Contralateral**
- Splenius cervicis & capitis
- Suboccipitals
**Ipsilateral**
- SCM
117
CSP - AROM - ROTATION - TISSUES COMPRESSED
**Ipsilateral**
- Splenius cervicis & capitis
- Suboccipitals
**Contralateral**
- SCM
118
CSP - POSTERIOR NECK MUSCLES
Occipitals
Upper trapezius
Splenius capitis
Splenius cervicis
Levator scapulae
Rhomboid minor
Spinalis capitis
Semispinalis capitis
Longissimus capitis
119
CSP - SUBOCCIPITAL MUSCLES
Rectus capitis posterior minor
Rectus capitis posterior major
Obliquus capitis inferior
Obliquus captifs superior
Interspinalis
120
CSP - ANTERIOR AND LATERAL MUSCLES
SUPERFICIAL TO DEEP
Platysma
Sternocleidomastoid
Trapezius
Omohyoid
Sternohyoid
Sternothyoid
Thyrohyoid
Middle scalene
Posterior scalene
Anterior scalene
Scalene's minimus
Levator scapulae
Rectus capitis lateralis
Rectus capitis anterior
Longus capitis
Longus cervicis
121
TRAPEZIUS - ORIGIN
SP of C7, Occiput, Nuchal ligament
122
TRAPEZIUS - INSERTION
Lateral 1/3 of clavicle, Acromion, Spine of scapula
123
TRAPEZIUS - ACTION
Elevation and retraction of the scapula
Extension of the neck
124
TRAPEZIUS - INNERVATION
Accessory nerve (CN XI)
Anterior rami of C3-C4
125
TRAPEZIUS - TRIGGER POINT REFERRAL
Just above the superior border of the scapula
Just inferior to the inferior angle of the scapula
126
TRAPEZIUS - STRETCH
Laterally flex head to one side and apply mild tension with opposite hand
To increase strength grip onto the side of the chair
127
TRAPEZIUS - STRENGTHEN
Resisted shoulder elevation
Shrug
Prone neck extension
128
LEVATOR SCAPULAE - ORIGIN
TPs of C1-C4
129
LEVATOR SCAPULAE - INSERTION
Medial border of scapula
130
LEVATOR SCAPULAE - ACTION
Elevation of scapula
Extension and lateral flexion of neck
131
LEVATOR SCAPULAE - INNERVATION
Dorsal scapular nerve (C3-C5)
132
LEVATOR SCAPULAE - TRIGGER POINT REFERRAL
Angle of the neck
Just superior to the scapula attachment of the muscle
133
LEVATOR SCAPULAE - STRETCH
Contralaterally flex, contralaterally rotate and flex the head and apply mild tension with the opposite hand
134
LEVATOR SCAPULAE - STRENGTHEN
Resisted shoulder elevation
Shrug
Prone neck extension
135
SPLENIUS CAPITIS - ORIGIN
SPs of C3-T4
Nuchal ligament
136
SPLENIUS CAPITIS - INSERTION
Mastoid process of temporal bone
Occipital bone (superior nuchal line)
137
SPLENIUS CAPITIS & CERVICIS - ACTION
**Unilateral** - Ipsilateral rotation and lateral flexion of the head and neck
**Bilateral** - Extension of the head and neck
138
SPLENIUS CAPITIS & CERVICIS - INNERVATION
Cervical spinal nerves (dorsal rami)
139
SPLENIUS CERVICIS - ORIGIN
SPs of T3-T6
140
SPLENIUS CERVICIS - INSERTION
TPs of C1-C3 (posterior tubercles)
141
SPLENIUS CAPITIS & CERVICIS - TRIGGER POINT REFERRAL
Muscle belly and refer pain over the posterior neck, above the ear, at the top of the head
142
SPLENIUS CAPITIS & CERVICIS - STRETCH
Flex, contralaterally flex and contralaterally rotate head to one side and apply mild tension with the opposite hand
143
SPLENIUS CAPITIS & CERVICIS - STRENGTHEN
Prone neck extension
Neck extension with head ipsilaterally rotated
144
STERNOCLEIDOMASTOID - ORIGIN
**Sternal head** - Top of sternum
**Clavicular head** - medial portion of clavicle
145
STERNOCLEIDOMASTOID - INSERTION
Mastoid process
146
STERNOCLEIDOMASTOID - ACTION
Flexion, lateral flexion and rotation of the neck
147
STERNOCLEIDOMASTOID - INNERVATION
Accessory nerve (CN XI) Anterior rami of C2-C4
148
STERNOCLEIDOMASTOID - TRIGGER POINT REFERRAL
Over the mastoid process and supraorbital regions of the face
149
STERNOCLEIDOMASTOID - STRETCH
Extend, contralaterally flex and rotate neck to contralateral side
150
STERNOCLEIDOMASTOID - STRENGTHEN
Supine neck curls with chin out
151
LONGUS CAPITIS - ORIGIN
TPs of C3-C5 (anterior tubercles)
152
LONGUS CAPITIS - INSERTION
Occipital bone
153
LONGUS CAPITIS - ACTION
Flexion of the head and neck
Lateral flexion of the head and neck
154
LONGUS CAPITIS - INNERVATION
Ventral rami C1-C3
155
LONGUS CAPITIS - STRETCH
Open jaw, extend head and neck
156
LONGUS CAPITIS - STRENGTHEN
Supine neck curls with chin tucked in
157
LONGUS CERVICIS - ORIGIN
Lower anterior veterbral bodies
TPs of C3-T3
158
LONGUS CERVICIS - INSERTION
Anterior vertebral bodies
TPs C1-C6
159
LONGUS CERVICIS - ACTION
Flexion and lateral flexion of neck
Rotation of neck (weak action)
160
LONGUS CERVICIS - INNERVATION
Ventral rami C2-C6
161
ANTERIOR SCALENE - ORIGIN
TPs of C3-C7 anteriorly
162
ANTERIOR SCALENE - INSERTION
Scalene tubercle of 1st rib
163
ANTERIOR SCALENE - ACTION
Flexion, lateral flexion and rotation of the neck
Elevation of 1st rib
164
ANTERIOR SCALENE - INNERVATION
Anterior rami of C4-C6
165
ANTERIOR SCALENE - STRETCH
Contralaterally flex and ipsilaterally rotate neck
166
MIDDLE SCALENE - ORIGIN
TPs of C2-C7
167
MIDDLE SCALENE - INSERTION
Superior surface of 1st rib
168
MIDDLE SCALENE - ACTION
Lateral flexion of neck
Elevation of 1st rib
169
MIDDLE SCALENE - INNERVATION
Anterior rami of C3-C8
170
MIDDLE SCALENE - STRETCH
Contralaterally flex neck and apply mild pressure with the opposite hand
171
POSTERIOR SCALENE - ORIGIN
TPs of C5-C7 posteriorly
172
POSTERIOR SCALENE - INSERTION
2nd rib
173
POSTERIOR SCALENE - ACTION
Ipsilateral lateral flexion of neck
Elevation of 2nd rib
174
POSTERIOR SCALENE - INNERVATION
Ventral rami C6-C8
175
POSTERIOR SCALENE - STRETCH
Laterally flex and contralaterally rotate neck
Apply mild pressure with opposite hand
